Curriculum

Curriculum

Residents passing through Allegheny General Hospital become well-rounded orthopaedic surgeons through clinical and didactic learning experiences.

 


 Clinical Experiences

 

For details of clinical experiences:

 

 Training Facilities

The main training facility is Allegheny General Hospital (AGH), a non-profit, Level 1 Shock Trauma Center that is one of the largest tertiary care centers in the region.  AGH's surgical facilities include:

  • Main OR - The main operating room consists of 27 surgical suites. On any given day there are between 4 and 6 orthopaedic attending physicians operating. In general, each attending physician schedules 5 to 10 cases each operative day, not including trauma and add-ons.  Turnover time varies with the type of case but averages 30 to 45 minutes, allowing ample time for post-op checks, last minute reading, orders, consults, or lunch.
  • Outpatient Surgery Center - The Outpatient Surgery Center is a 7-suite surgery center located on the 01 level of AGH. Two to three orthopaedic attending physicians operate in the Outpatient Surgery Center daily, scheduling between 3 and 14 cases each. The main services utilizing the surgery center include hand, sports, foot and ankle and general orthopaedics. Typical cases include arthroscopy, routine fracture care, carpal tunnel, etc.  Turnover time in the surgery center averages 20 minutes, allowing for efficient flow of operative cases.

 

Half of the pediatric orthopaedic rotation (3 months) is spent at Akron Children's Hospital, a 253-bed hospital located in downtown Akron, Ohio.  While at Akron, residents are provided a fully furnished 2-bedroom apartment that is fully paid for with monthly maid service, television, and Internet services as well as an in-unit washer and dryer. While at Akron, residents are regularly exposed to pediatric orthopaedic trauma as well as participating in the more advanced pediatric orthopaedic conditions that have been referred to Akron Children’s. Orthopaedic surgery residents from Akron General, Summa, Cleveland Clinic, and Affinity Health programs also rotate at Akron Children's Hospital.

[Clinical]

 

 Operative Experience

Residents training at Allegheny General Hospital become well-rounded orthopaedic surgeons as attested to by patients, fellowship directors, and faculty. The operative experience at AGH is extensive and begins during the 6-month orthopaedic rotation during PGY1. Early involvement in hands-on operative techniques allows the resident to refine and perfect his/her abilities over the 5-year program.

During the orthopaedic Internship, interns spend 6 months rotating through the orthopaedic service. Their duties include coverage during the day shift as well as night float to experience all aspects of orthopaedic trauma at a Level 1 trauma center. When on the orthopaedic pager rotation, the PGY1 resident is primarily responsible for managing emergency department and floor consults. While on the orthopaedic joints rotation, they spend their month mirroring the schedule of an adult reconstruction surgeon, assisting in the operating room and in clinic hours. During down time the interns are strongly encouraged and welcome to assist in the OR.

Case logs begin in PGY1. Residents leave the program with 1,800 to 2,500 procedures logged over the course of 4 years. Because of the attending-to-resident ratio, it is rare for more than one resident to be present in any one surgical case, but not uncommon for cases to go without resident coverage. This allows the resident to obtain a tremendous hands-on surgical experience.

 

 A Day in the Life
 

Intern Year

The Orthopaedic internship is run in coordination between the General Surgery department and the Orthopaedic department. It consists of 6 months of Orthopaedics and 6 months of General Surgery Services. An intern year program takes place as lead by Dr. Mark Sangimino and takes place every Thursday throughout the year, no matter what rotations interns are on. The group will meet and discuss various orthopaedic pathologies, as well as the ins and outs of the operating room, use of the orthopaedic tables, casting, as well simulation testing which takes place throughout the year to adequately prepare interns for the upcoming orthopaedic years.

Orthopaedic months:

  • Pager – 3 months
  • Adult Reconstruction - 3 months

 

General Surgery months:

  • Emergency Department
  • Plastic Surgery
  • Vascular Surgery
  • Neurosurgery
  • Trauma ICU
  • Trauma night float

 

Ortho Pager:
The intern will hold the call pager for all ED consults, floor consults, and floor calls. Goals for the rotation include becoming proficient in evaluation of orthopaedic consults, learning about the various orthopaedic pathologies, formulation of a differential diagnosis, and skill in communication, evaluation, and management of orthopaedic patients.

Adult Reconstruction:
The remaining 3 months will be spent with an adult reconstruction surgeon in both the operating room and clinic. Goals will include developing a foundation for the field of adult reconstruction in the evaluation, diagnosis, and management of orthopaedic patients as well as a foundation for orthopaedic trauma.

Emergency Department:
The ED rotation is made up of 17-20 shifts over the month including both day and night shifts.  Goals for the rotation include exposure to various pathologies across the spectrum of medicine, management of acute patients, ability to manage patients from a medical standpoint.

Plastic Surgery:
Residents will typically take 2 weeks of hand surgery call while on service. Goals for the service include evaluation and management of soft tissue injuries as well as knowledge of available reconstruction options utilizing grafts and flaps.

Vascular Surgery:
Primary goals for the service are to become proficient in management of patients with vascular insufficiency, evaluation of acute vascular injury, as well as coordinated care with the orthopaedic surgery service.

Neurosurgery:
This rotation is a hybrid of neurosurgery and orthopaedics, with an emphasis on spine. Interns will work with the spine surgeons within the Neurosurgery department, spending two days a week in the OR and one day a week in clinic. In addition, two days per week are free for working on research or for helping the Ortho Pager intern. Goals for the rotation are to become proficient in office evaluation of spine patients with various pathologies and become comfortable in operative management of spine cases.

Trauma ICU:
This ICU month exposes interns to the care of critically ill patients who sustain trauma. The service is made up of 3-4 residents from various departments. Goals of this service involve the management of patients that are critically ill, who may have injuries in multiple organ systems. This rotation allows orthopaedic interns a look at managing the patient not from an orthopaedic standpoint, but from an overall view to allow greater integration with other health care teams.

Trauma Nights:
Trauma night float duties include responding to all level 1 and 2 traumas along with a senior trauma resident, taking care of floor calls, and occasionally operating on emergency cases. Interns will be exposed to a variety of injury mechanisms including blunt and penetrating trauma, and will become proficient in the triage, evaluation, and management of trauma patients.

[Clinical]

 

 Call Schedule

The administrative chief resident is responsible for developing the call schedule. In-house call is covered by the “night float” resident (PGY2 or 3). Beginning in October, PGY2 residents will each rotate through the night float rotation 6 weeks at a time for two rotations. The night float rotation is its own rotation so that the rotating resident is free from other responsibilities. The week begins with a 24-hour shift on Sunday as well as 4 night shifts (Monday through Thursday) over the course of the week. Friday and Saturday night call is covered the on-call PGY2 or PGY3 residents.

A PGY4 or PGY5 resident will be available on a nightly basis as the back-up resident (home call). The back-up resident is available to answer routine questions from the junior residents, evaluate difficult patients, or operate as necessary.

Weekend rounds will be covered by on call residents and back up residents. The backup resident gains additional operative experience, is available in house to answer questions, and frees up the on call resident to handle emergency and floor responsibilities. If the on call resident is free to operate, they are encouraged to join the backup resident in the operating room.

Typically, each PGY2 resident is responsible for 6 weeks of night float as well as one Friday and one Saturday call a month (except the first PGY2 resident who completes the night float rotation in June). PGY3 residents are responsible for 6 weeks of night float  in addition to 1-2 Friday calls a month. PGY4 and PGY5 call is composed of resident back up distributed evenly amongst all senior residents.

We maintain a 100% compliance policy with the 80-hour work-week as set forth by the ACGME. Clinical medicine is a time-consuming undertaking, and throughout our residency program, it is of the utmost importance to deliver quality care. Subsequently, we believe that residents should not be involved in direct patient care if their performance is impaired by fatigue. Resident work hours are limited to 80 hours per week averaged over the course of one month. At least one day in seven is free of academic and clinical responsibility, regardless of type of call. Hours worked by “back-up” call residents after being “called in” count toward the 80 hour work week. Residents are required to log in and log out on a daily basis to help monitor work hours.
 

[Clinical]

 

 Schedules

Daily Schedule

The schedule for any given day varies depending on the rotation schedule and the caseload. Some rotations lend themselves to a more hectic schedule than others (Trauma),  while other rotations contain a significantly larger clinical component. The schedule does vary slightly from class year to class year; however, such variations are minor and generally involve carrying the call pager during the day.

In general, the residents arrive at work around 5 a.m. and round until 6 a.m., at which time they attend the daily fracture conference until 6:30 a.m. At 6:30 a.m., all residents attend didactic lecture until 7 am. At 7:30 a.m., the first cases are being brought to the operating room and the operative day commences. Typically, there is enough time between cases to write orders, dictate, and eat, or brush up on upcoming cases.

Weekly Schedule

The following is a rundown of the weekly schedule for each rotation (subject to change):

Rotation
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
Joints Senior
OR NGS
Office NGS
OR NGS
Office NGS/ Research
OR NGS/ OR JJS
Joints Junior
OR JJS
Office JJS
OR NGS
OR JJS
OR JJS
Hand A
OR BAP
Office BAP
OR BAP
Research
OR BAP
Hand B
Office PT
OR EB
OR PT/ Office EB
OR EB
OR PT
Foot & Ankle
OR AW
Office AW
Office VRP
OR VRP
Foot & Ankle Trauma/Research
AGH Pediatrics
OR MJS
Office MJS
OR SSJ/ MJS Office
OR MJS/ Research
Office SSJ
Sports Senior
OR PJD
OR PJD/ Research
OR DJP/SA
OR DAF
 OR PJD
Sports Junior
OR DJP
OR DAF
OR RES/ Research
OR DAF
Office DJP
Spine
OR GS
Research
OR DTA/ OR GS
Office DTA
OR DTA
Trauma Senior
OR DTA
OR GTA/ OR EW
OR DTA/ OR EW
OR GTA/ OR EW
OR EW
Trauma Junior
Office EW
OR EW/ OR GTA
OR EW/ OR DTA
OR EW/GTA
OR EW
Joints Intern
OR T JS
Office T JS
Office T JS
OR T JS
Trauma pager

 

Annual Schedule

Please view the PDF of the 2014-2015 PGY2-PGY5 Rotation Schedule to see a sample annual schedule for all of our orthopaedic surgery residents.

[Clinical]

 


 Didactic Learning Experiences

 Morning Conference Schedule

  • Monday - Spine or Pediatrics every alternating week
  • Tuesday - Foot & Ankle/Biomechanics/Basic Science
  • Wednesday - Upper Extremity Fracture Conference/Hand Topic Lecture
  • Thursday - Trauma or Adult Reconstruction every alternating week
  • Friday - Sports

 

Attendance at lectures is mandatory except in the event of an emergency. All residents are expected to  participate in conferences from 6 to 7:30 a.m. daily (except on Tuesday, when the conference runs until 8 a.m.). This begins with fracture conference daily from 6 to 6:30 a.m. Specialty conferences follow from 6:30 to 7:30 a.m.

Regular conferences run from September through May. Methods of teaching will include didactic lecture for a majority of conferences, with interspersed sawbones, cadaver dissection and arthroscopy labs. A resident will lead conferences with an attending physician present.

The conference schedule in July and August is made up of a summer lecture review series. This is a comprehensive lecture series aimed at reviewing the basics of the orthopedic history and physical exam, X-rays, anatomy and basic operative skills.

Morbidity and mortality conference occurs on one Tuesday every month preceding grand rounds. The resident involved in the index procedure/initial case is responsible for presenting the complication. Residents will present two case presentations every month for grand rounds.

Journal Club occurs on a monthly basis and is specialty specific.

Sample monthly educational curriculum (October 2013)

[Didactic]

 

 2014-2015 Visiting Professors

 

Brian J. Cole, MD, MBA
Professor, Department of Orthopaedics,
Department of Anatomy and Cell Biology;
Section Head, Cartilage Restoration Center at Rush
Rush University Medical Center

Jacques D’Astous, MD
Shriners Hospital for Children
Orthopaedics - Professor (Clinical)
Physical Therapy - Adjunct Associate Professor
Salt Lake City, Utah

Steven L. Frick, MD
Surgeon-in-Chief and Chairman, Department of Orthopaedic Surgery
Nemours Children’s Hospital
Professor of Orthopaedic Surgery
Assistant Dean University of Central Florida College Medicine
Orlando, Fla.

Steven R. Garfin, MD
Professor and Chair, Department of Orthopaedic Surgery
Chief of the University of California San Diego Spine Program
University of California, San Diego School of Medicine
San Diego, Calif.

Christopher M. Jobe, MD
Professor, Orthopaedic Surgery
Chief, Sports Medicine
Loma Linda University School of Medicine
Loma Linda, Calif.

Christopher C. Kaeding, MD
Professor, Department of Orthopaedic Surgery
Chief, Division of Sports Medicine
Director, Sports Medicine Center
Director, Orthopaedic Sports Medicine Fellowship
Head Team Physician, The OSU Athletic Department

Alex J. London, PhD
Professor of Philosophy
Director, The Center for Ethics and Policy
Carnegie Mellon University
Pittsburgh, Pa.

Sohail Mirza, MD, MPH
Professor of Orthopaedic Surgery and of the Dartmouth
Institute for Policy and Clinical Practice, Geisel School of Medicine
Dartmouth-Hitchcock Medical Center, Spine Center
Lebanon, NH

Al Mollabashy, MD
Medical Director, Orthopaedic Oncology Service
Baylor University Medical Center
Dallas, Texas

Jessica L. Valletta, MD
Pain Medicine
Allegheny Health Network
Pittsburgh, Pa.

Heather A. Vallier, MD
Professor of Orthopaedic Surgery,
Clyde L. Nash, Jr. M.D. Professor of Orthopaedic Education
Case Western University
Cleveland, Ohio

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